Dermatologic Manifestations of Glomus Tumor Workup
- Author: Jon H Meyerle, MD; Chief Editor: Dirk M Elston, MD more...
Routine laboratory studies are not helpful in patients with glomus tumors. The rare exception is in patients with widely disseminated lesions in which platelet sequestration is a concern. In these patients, a CBC count is indicated.
While the diagnosis of a glomus tumor is often made on clinical and histologic grounds, imaging may prove useful, especially in cases in which the diagnosis is in doubt.
Plain radiography has been reported to reveal bony erosions, especially in the case of subungual lesions. Ultrasonography, especially color-duplex ultrasonography, has a high detection rate and no false-negative results, at least in one series; additionally, ultrasonography can detect glomus tumors as small as 2 mm.[23, 24, 25]
MRI has also been studied and may be particularly useful for the detection of multiple tumors[26, 27] or in cases in which the diagnosis or specific location of the lesion is in question. High-resolution MRI has proven useful as well.[28, 29]
Solitary and multiple glomus tumors have distinct histopathologic features.
Solitary lesions appear mostly as solid, well-circumscribed nodules surrounded by a rim of fibrous tissue. They contain endothelium-lined vascular spaces surrounded by clusters of glomus cells. The glomus cells are monomorphous, round or polygonal cells with plump nuclei and scant eosinophilic cytoplasm. Note the images below.
Multiple lesions are less well circumscribed and less solid appearing than their solitary counterparts. Multiple lesions have the overall appearance of a hemangioma. They contain multiple irregular, dilated, endothelium-lined vascular channels that contain red blood cells. The vascular spaces are larger than those in a solitary glomus tumor. Small aggregates of glomus cells are present in the walls of these channels and in small clusters in the adjacent stroma. Multiple glomus tumors have more narrow and focal aggregates of glomus cells than solitary lesions. The overall appearance of multiple glomus tumors accounts for their alternate name, glomangiomas. Note the images below.
Glomangiosarcomas resemble benign glomus tumors. However, glomangiosarcomas have more atypia, pleomorphism, and mitotic figures, and they have an invasive growth pattern. Most often, foci of benign glomus tumor are correlated with malignant lesions.
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